Provider Demographics
NPI:1134287519
Name:HENDRICKS, CAROLYNN SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROLYNN
Middle Name:SUE
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 PINE CIR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8940
Mailing Address - Country:US
Mailing Address - Phone:770-205-3164
Mailing Address - Fax:770-813-9661
Practice Address - Street 1:10360 MEDLOCK BRIDGE RD
Practice Address - Street 2:SUITE J
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-5927
Practice Address - Country:US
Practice Address - Phone:770-813-9660
Practice Address - Fax:770-813-9661
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1040907OtherBCBS - ASHN PROVIDER ID #
GA664620OtherUHC - ACN PROVIDER ID #
GA2057186OtherAETNA HMO PROVIDER ID #
GA4413651OtherAETNA PPO PROVIDER ID #
GA2057186OtherAETNA HMO PROVIDER ID #
GAU47519Medicare UPIN